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Year 3 - Paediatrics > Intro to neonatology > Flashcards

Intro to neonatology Flashcards

1
Q
  • Be familiar with the physiological differences of neonates and changes that occur after birth
  • Understand the common problems associated with being small for dates
A

.

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2
Q

CVS starts developing in what week

A

End of 3rd week

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3
Q

Foetal circulation

  • function of ductus venosus
  • function of foramen ovale
  • function of ductus arteriosus
A

DV - shunts blood from umbilical vein directly to IVC, so allowing OXYGENATED blood from placenta to bypass the liver

FO - a hole in the septum between the 2 atria shunting blood from left atrium to right atrium

DA - shunts blood from the pulp artery to the descending aorta, allowing blood to bypass lungs (so carries LOW OXYGENATED BLOOD)

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4
Q

What happens to the following after birth

  • ductus venosus
  • foramen ovale
  • ductus arteriosus
  • umbilical arteries
A

DV - ligamentum venosum

FO - becomes fossa ovalis in RA

DA - becomes ligamentum arteriosum

Umbilical arteries - some becomes *MEDIAL umbilical ligament, some stays open as branch of internal iliac

*DON’T CONFUSE WITH MEDIAN UMBILICAL LIGAMENT = REMNANT OF EMBRYONIC URACHUS

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5
Q

Normal vital signs of full term newborn

  • BP
  • RR
  • HR
A

BP - 70/44

RR - 30-60

HR - 120-160
–> bradycardia <100

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6
Q

How is a baby’s temp regulated

  • in utero
  • newborn
A

In-utero - relies on mum’s thermoregulation

Newborn - lack shivering thermogenesis so need metabolic source of heart instead = BROWN FAT (packed with mitochondria to burn energy when needed)

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7
Q

Heat is lost through what 4 processes

A

Radiation
Convection
Evaporation
Conduction

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8
Q

How is newborn breathing investigated

A

NIV

  • Blood gas
  • -> PaCO2 = 5-6kPa
  • -> PaO2 = 8-12 kPa

Invasive

  • capnography
  • flow volume loop
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9
Q

Physiological jaundice appears within how many days of birth and disappears within how many

A

2-3

7-10 for term and up to 21 for preemies

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10
Q

Why does physiological jaundice occur in babies

A

Babies have a high number of RBCs in their blood, which are broken down and replaced rapidly (HIGH CELL TURNOVER) so lots of bilirubin produced which is not removed from the body quick enough by the liver as it’s not fully developed yet

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11
Q

High concentrations of bilirubin in blood can cause an irreversible change in the brain called what

A

KERNICTERUS - just refers to high bilirubin levels crossing BBB and damaging brain

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12
Q

Neonatal jaundice only treated when it become *pathological (acute bilirubin encephalopathy)

What’s the treatment? (2)

*usually is just physiological

A

Exchange transfusion - removing their blood and giving new blood

+ phototherapy

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13
Q

Why is phototherapy given to babies with pathological jaundice?

A

Blue light converts bilirubin to water soluble form and increases oxidation of bilirubin so decreasing blood conc. of it

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14
Q

Full term baby is able to maintain fluid balance

Weight loss of up to 10% is normal in newborns

In what ways is fluid lost?

A

Shift from interstitial to intravascular

Diuresis - peeing it out

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15
Q

It’s normal not to pass urine for the first … hours

A

24

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16
Q

Why is fluid balance abnormal in premature babies?

A

Less fat

Increased kidney loss
-reduced Na reabsorption and reduced ability to concentrate or dilute urine

Increased insensible water loss
-e.g. sweating, breathing

17
Q

Newborns get normal physiological anaemia

They’re born with Hb 15-20g/L but this falls when and to how much?

But increases in what week?

A

Week 10 - Hb 11

Week 20 - to Hb 12

18
Q

Premature babies are very susceptible to anaemia - why?

A

Low erythropoiesis
Infection
Getting blood withdrawn (for tests)

19
Q
  • Establish neonatal definitions.
  • Describe routine management and care of the premature baby.
  • Understand short and long term complications of being born prematurely.
  • Understand the potential outcomes of extreme premature birth
A

.

20
Q

Low birth weight =
Very low birth weight =
Extremely low birth weight =

A

<2500g
<1500g
<1000g

21
Q

How many weeks

  • preterm baby
  • extremely preterm baby

-what is considered the youngest age viable for a premature baby

A

<37 weeks

<28 weeks

24 weeks

22
Q

Maternal causes of babies being small for gestational age

A

Smoking

Pre-eclampsia - decreases perfusion of placenta

Carrying twins

23
Q

Foetal causes of being small for gestational age

A

Chromosomal syndromes, e.g. down’s, edward’s

Congenital infection, e.g. CMV

24
Q

Placental causes of being small for gestational age

A

Placental abruption

25
Q

Short term complications for baby of being small for gestational age

A 
Perinatal hypoxia
Hypoglycaemia
Hypothermia
Polycythaemic, thrombocytopenia
GI PROBLEMS - NEC, poor feeding
ARDS
26
Q

Long term complications for baby of being small for gestational age

A

Hypertension
Reduced growth
Obesity
IHD

27
Q

Common short term complications of premature babies

A

RDS

Ventilation management and complications, e.g. pneumothorax

Biochemical disorders, e.g. acidosis

Temperature control

Nutrition and fluid management
Infection, e.g. necrotising enteric colitis (NEC)

Brain haemorrhage (IVH)

Circulatory issues (e.g. PDA - persistent ductus arteriosus)

Jaundice

28
Q

A short term complication of premature (preterm) babies is RESPIRATORY DISTRESS SYNDROME

How can this be prevented before birth?

What is the treatment for the newborn?

A

Steroids (dexamethasone) to the mother

Surfactant ASAP
NIV

29
Q

A mild short term complication of premature babies is apnoea/irregular breathing

How is this treated? (2)

A

Caffeine

NIV (CPAP)

30
Q

A short term complication of preterm babies is IVH (intraventricular haemorrhage)

How can this be prevented before birth?

What is the treatment for the newborn?

A

Steroids (dexamethasone) for mother

Supportive care mainly
-SYMPTOMATIC relief for newborn

31
Q

A short term complication of preterm babies is IVH

Long term complications of premature babies

A

Retinopathy of Prematurity (ROP)

Periventricular leukomalacia (PVL)

Post haemorrhagic hydrocephalus (PHH)

Chronic lung disease/ Broncho Pulmonary Dysplasia (BPD)

Developmental delay and cerebral palsy

Poor growth

32
Q

Post haemorrhage hydrocephalus (PPH) is a long term complication in premature babies

It involves bleeding into the CSF which increases ICP and progressively DILATES VENTRICLES; usually follows IVH

What is the treatment of the newborn?

A

VP shunt

33
Q

Patent ductus arteriosus is a short term complication of premature babies

What does it lead to?

A

Usually connects pulm artery to aorta so blood can bypass lungs but persistent patency can cause blood from the aorta to leak back to pulm circulation –> increasing pulm pressure –> lung oedema
–> also stealing from systemic circulation –> systemic ischaemia

34
Q

Complications of patent ductus arteriosus

A

Respiratory distress syndrome

Hypoperfusion of end organs, e.g. necrotising enterocolitis (from GI ischaemia)

CHF long term

35
Q

Necrotising enterocolitis is a short term complication in premature babies

It involves ischaemia of the bowel –> necrosis

What is the treatment?

A

Supportive

  • STOPPING MILK FEEDS to let bowel rest
  • IV nutrition instead (not milk)
  • Antibiotics - if infection

Surgical

  • gastric decompression
  • abdominal drain
  • laparatomy - to resect dead bowel
36
Q

Potential outcomes of EXTREME PREMATURITY

A

Death
Normal
Physical or learning disability

Year 3 - Paediatrics (11 decks)

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